The Cancer Drugs Fund (CDF) is expected to save the U.K. National Health Service (NHS) a minimum of £140 million over the next five years. Medicines that are recommended to the CDF by NICE (National Institute of Health and Care Excellence) have their prices negotiated lower than the manufacturer’s initial listed price. Over 15,000 patients have been treated with the 52 drugs that have been funded through the CDF since the body was reformed in 2016, and many of these patients were treated more quickly than they would have been pre-reforms. The new system allows appraisals of these drugs to begin much earlier than previously, helping patients in desperate need have more access to novel therapies. (January
Before the reform in 2016, it was widely believed that the fund was a poorly executed system designed as a populist gesture. During the first iteration of the CDF, over 100,000 patients received treatment with drugs reimbursed through the fund, costing U.K. taxpayers over £1.2 billion. It was thought that the CDF hugely overpaid for many drugs with limited efficacy that resulted in big pharma reaping the rewards.
Following the recommendation of an independent report, the core activities of the CDF were reviewed and transformed. Since then it has become a much more effective entity which is closer to performing its original stated ambition. The CDF now works with more supervision from NICE, and is able maintain a tough stance in negotiations with pharmaceutical companies whose drugs fail to meet the necessary cost-effectiveness score for standard reimbursement. This makes the CDF much less of a drain on public resource whilst also providing many patients with severe cancers the chance to benefit from some of the newest therapies currently available.
Despite the recent success claimed by the NHS, cancer survival rates in the U.K. still lag behind those of other developed nations, and below the European average. Though the CDF is helping, there have long been issues surrounding NICE and its reimbursement of cancer drugs. The QALY system has never been too kind to these types of cancer drugs, especially end-of-life treatments, but recent changes are beginning to combat this. The introduction of higher QALY thresholds for end-of-life treatments and highly specialised therapies has gone some way to help. But the historic disinterest of NICE in reimbursing the cancer drugs of the day has left the standard of care in many cancers far behind that of other countries. This makes conducting trials that compare their drug to the standard of care much more difficult for pharmaceutical companies.